We are authorized to collect personally identifiable information (PII) from you. Any PII we collect is used to solely to quote medical insurance and/or assist you with service requests. If you choose to give us PII, we may share this information with only insurance carriers and providers. PII is used or disclosed only under the following circumstances: obtaining quotes and servicing requests. This request of PII is voluntary, however, may be absolutely necessary to complete your request. If you choose not to provide us with the PII requested, or not to respond to certain questions,we will not be able to assist you.
Section II(a) of the Individual Marketplace Privacy and Security Agreement identifies the following authorized functions for which an agent or broker may create, collect, disclose, access, maintain, store, and use PII in the Federally-facilitated Individual Marketplace and an SBM-FP Individual Marketplace.
- Assisting with applications for QHP eligibility
- Supporting QHP selection and enrollment by assisting with plan selection and plan comparisons
- Assisting with applications for the receipt of advance payments of the premium tax credit (APTC) or cost-sharing reduction (CSR), and selecting an APTC amount
- Facilitating the collection of standardized attestations acknowledging the receipt of the APTC or CSR determination, if applicable
- Assisting with the application for and determination of certificates of exemption
- Assisting with filing appeals of eligibility determinations in connection with the Marketplace
- Transmitting information about the consumer’s, applicant’s, qualified individual’s, or enrollee’s decisions regarding QHP enrollment and/or CSR and APTC information to the Marketplace
- Facilitating payment of the initial premium amount for the appropriate QHP
- Facilitating an enrollee’s ability to disenroll from a QHP
- Educating consumers, applicants, or enrollees on insurance affordability programs and, if applicable, informing such individuals of eligibility for Medicaid or the Children’s Health Insurance Program
- Assisting an enrollee’s ability to report changes in eligibility status to the Marketplace throughout the plan year, including changes that may impact eligibility (e.g., adding a dependent)
- Correcting errors in the application for QHP enrollment
- Informing or reminding enrollees when QHP coverage should be renewed or when enrollees may no longer be eligible to maintain their current QHP coverage because of age, or to inform enrollees of QHP coverage options at renewal
- Providing appropriate information, materials, and programs to inform and educate consumers, applicants, qualified individuals, and enrollees about the use and management of their health information and services and options offered through the selected QHP and among the available QHP options
- Contacting consumers, applicants, qualified individuals, and enrollees to assess their satisfaction or resolve complaints with services provided by the agent or broker in connection with the Marketplace or QHPs
- Providing assistance in communicating with QHP Issuers
- Carrying out the agent’s or broker’s legal responsibilities related to QHP issuer functions in the Marketplace, as permitted or required by the agent’s or broker’s contractual relationships with QHP issuers
- Other functions substantially similar to those enumerated above and such other functions that may be approved by CMS in writing from time to time
Section II(a) of the SHOP Privacy and Security Agreement identifies the following authorized functions for which an agent or broker may create, collect, disclose, access, maintain, store, and use PII in the SHOP. The references below to the “SHOP Marketplace” include both FFMs and SBM-FPs.
- Assisting with application, eligibility, and enrollment processes for QHPs offered through the SHOP Marketplace
- Supporting SHOP Marketplace QHP selection and enrollment by assisting with plan comparisons and plan selection
- Facilitating employer premium contribution amount selections through the SHOP Marketplace
- Facilitating payment of the initial and subsequent group premium amount for SHOP Marketplace coverage
- Facilitating employee and dependent enrollment and disenrollment in QHPs offered through the SHOP Marketplace
- Handling SHOP Marketplace coverage changes throughout the plan year that may impact eligibility, including adding a new hire, removing an employee no longer employed at a company, removing an employee no longer employed full-time, and adding a newborn or spouse during a special enrollment period
- Assisting with filing appeals of SHOP Marketplace eligibility determinations
- Providing customer service activities related to SHOP Marketplace coverage if permitted under state and federal law, including correction of errors on SHOP Marketplace applications and policies, handling complaints and appeals regarding SHOP Marketplace coverage, responding to questions about SHOP Marketplace insurance policies, assisting in communicating with SHOP Marketplace issuers, assisting with communicating with state regulatory authorities regarding SHOP Marketplace issues, and assistance in communicating with CMS and SHOP Marketplace Workforces
- Conducting quality assurance activities, including assessment of consumer satisfaction related to the agent’s or broker’s assistance with SHOP Marketplace coverage
- Providing information, materials, and programs to educate consumers, applicants, employers, employees, qualified employers, qualified employees, and enrollees about the use and maintenance of their SHOP Marketplace health coverage and policies
- Carrying out the agent’s or broker’s legal responsibilities related to QHP issuer functions in the SHOP Marketplace as permitted or required by the agent’s or broker’s contractual relationships with QHP issuers
- Other functions substantially similar to those enumerated above and such other functions that may be approved by CMS in writing from time to time.